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Personality Disorders (PDs) involve diverse problems: difficult interpersonal relationships, symptoms, behaviors preventing the achievement of
primary goals, poor impulse control, and so on. To comprehend patients
behavior it is not enough to just list these problems; we also need to explain how these features co-occur and remain unchanged over the years.
The explanation we offer is based on a description of how self-functions
are damaged in PDs and how self-functions interact to form the various
disorders. This makes it possible to build a model showing how heterogeneous factors interact to lead to unitary forms of functioning. We consider
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elements of the self, when damaged, play a role in PDs and then show how
these dysfunctions interact to perpetuate PDs over time. We propose that
the self pathology underlying PDs involves problems with: (1) organizing
subjective experience into narrative form; (2) the ability to represent ones
own and others minds; (3) interpersonal schemas; (4) decision-making
reasoning processes.
The first element is the form and contents of subjective experience. PD
patients often have intense and extremely negative experiences, from
which they are unable to escape. Alternatively, some experiences are egosyntonic but patients seek them compulsivelylike the gratification due
to anothers presence in dependents or the feeling of superiority in narcissistsand this hinders social adaptation. Individuals communicate by
telling stories, with meaning themes, emotions and their vision of the
world. We therefore need to describe the cognitions and emotions typical
of patients self-narratives and how these stories are organized (or fail to
be). The second is the ability to represent psychological states to oneself.
PD patients have difficulty in building integrated representations of self
and others. Our hypothesis is that this is due to dysfunctions in the ability
to build metarepresentations. The third element is problematical interpersonal relationships. People possess preconceptions or cognitive schemas
that are used to anticipate events and make sense of the myriad of stimuli
impinging on them (Cottraux & Blackburn, 2001; Higgins & Bargh, 1987;
Kelly, 1955; Neisser, 1976; Piaget, 1964). Segal (1988) defined schemas as:
organized elements of past reactions and experience that form a relatively
cohesive and persistent body of knowledge capable of guiding subsequent
perception and appraisals (p. 147). Of particular importance are interpersonal schemas, which anticipate and attribute meaning to relationships
(Baldwin, 1992). There are a limited number of interpersonal schemas in
PDs and they mainly feature negative representations of the self vis-a`-vis
others represented as hostile, rejecting, distant, untrustworthy and so on.
As a result patients, for example, suffer for the expectation that their goals
will not be achieved because of the harm others are going to cause. They
are often incapable of asking for help or co-operating because they foresee
others not assisting. Moreover their anticipatively negative attitude evokes
responses in others that are consistent with the schemas and reinforce
their pathogenic expectations and dysfunctional behavior (Mitchell, 1988;
Safran & Muran, 2000).
Lastly, we need to look at how people reason and choose. As part of
general society, we have to opt between various possible actions and forms
of conduct, e.g., whether to embark on a career requiring travel or to devote ourselves to our children. Making the right choices promotes adaptation, whereas dysfunctional choice mechanisms cause harm. PD patients
find it difficult to set goals or self-regulate when they have set them
(Clarkin, 2005; Dimaggio, Nicolo`, Popolo, Semerari, & Carcione, 2006).
Their decisions are often guided by heuristics and biases that lead them
to adopt goal-reaching strategies doomed to failure.
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gets identified as I. Each character embodies a facet of the self and the
characters can be pinpointed in patients discourses, in both written texts
(studying transcripts, Stiles et al., 2004) and inflexions of the voice (analyzing audio-files: Osatuke, Glick, Gray, & Stiles, 2004).
Given these theoretical, clinical, and experimental observations, it is
plausible to postulate that when PD patients tell stories they experience
them subjectively as distinct states of mind populated by a cast of voices
typical of their disorder. An additional hypothesis is that each PD is characterized by a typical set of states of mind (Dimaggio, Semerari et al.,
2006). For example, narcissistic personality disorder is characterized by
the following states: a. grandiose; b. depressed/terrified; c. detached emptiness; and d. impulsive and angry state with tendency to acting-out (Dimaggio, Semerari, Falcone, Carcione, Nicolo`, & Procacci, 2002). Youngs
(1990) descriptions of narcissists self-states are similar: self-aggrandizer,
detached self-soother, and vulnerable child. Studies using repertory grids
(Kelly, 1955) show that borderline disorder is characterized by a particular
set of states termed: ideal, abuser rage, powerless victim, angry victim,
coping, and zombie (Bennett, Pollock, & Ryle, 2005; Golynkina & Ryle,
1999).
Explaining PDs in narrative terms induces clinicians to build up a map
of the whole set of stories their patients tell. Clinical experience and session transcript analysis show that, even in the most serious PDs, where
experience is most limited, e.g., paranoid (Salvatore, Nicolo`, & Dimaggio,
2005), the self is multifaceted and a certain number of themes can be observed. The narrative approach is therefore in line with the criticisms made
of the DSM, i.e., that it portrays disorders in an almost caricatural way,
pointing to only one facet of a personality or one narrative theme. The
research by Westen & Shedler (2000; Shedler & Westen, 2004) shows that
PD patients narratives do indeed concentrate on one dominant theme, but
there are also likely to be secondary themes, generally not included in the
corresponding DSM category.
Millon and Davis (1996) similarly consider PDs multifaceted entities. In
their model each disorder has a central part composed of several elements
(beliefs, behavioral styles, etc.), which constitute the core of its prototype,
plus secondary facets representing its subtypes. We can, for example, talk
of avoidant individuals with dependent traits, which, translated into narrative terminology, signifies swinging between a dominant themesensitivity to critical opinions and to feeling ashamed, with a tendency to isolationand dependency on reassuring and nonjudgmental figures, by
whom one lets oneself be guided in ones actions.
Narrative theory has the advantage of being easy to apply clinically: The
amount of inference needed to identify the principal self states contents is
minimal. Moreover, thinking in term of narrative themes is a good basis
for research on the psychotherapy process, both via methods pinpointing
dominant constructs and narratives, such as Kellys repertory grids or
self-investigation (Hermans & Hermans-Jansen, 1995), and via others
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METACOGNITIVE SKILLS
Cognitive science, developmental psychology, clinical practice, and philosophy (Dennett, 1991) agree on some basic assumptions for comprehending personality dysfunctions. The first is that there needs to be a set of
mechanisms by which an individual can perceive and express inner experience in language, and also read others minds accurately and sensitively.
For example, the physiological activation of an unpleasant arousal can
induce individuals to distance themselves from a stimulus, but they do
not necessarily recognize it as fear (Zajonc, 1980). The processes by which
one is able to identify inner states, to label them linguistically and reason
about them, to ascribe states of mind to others on the basis of their behavior and to reason about states of mind, are termed: theory of mind (Leslie,
1987; Baron-Cohen, Leslie, & Frith, 1985), reflexive function or mentalization (Fonagy, Gergely, Jurist, & Target, 2002), psychological mindedness
(Applebaum, 1973; Conte, Plutchik, Jung, Picard, Karasu, & Lotterman,
1990), metacognition (Flavell, Miller, & Miller, 1993), and metarepresentative or metacognitive skills (Semerari et al., 2003b; Sperber, 2000).
There is currently a heated debate about the nature and origins of metacognition. Some maintain that reading others minds is done using a true
and proper Theory of Mind (ToM), which gets developed from an innate
brain module (Leslie, 1994); others that this skill is essentially interpersonal and depends on how an infant interacts with caregivers right from
birth (Carpendale & Lewis, 2004; Tomasello, Carpenter, Call, Behne, &
Moll, 2005). The existence of the so-called mirror neurons supports the
interpersonal hypothesis. Mirror neurons get activated both when individuals are about to perform an action, and when they see the same emotion
or behavior activated in conspecifics (see Gallese & Lakoff for a review of
this topic). As a result, the understanding of others does not need to be
based on ToM for them to be represented in our minds in part as if they
were ourselves. Despite the disagreements, several points appear to be
sound and empirically based (Semerari, Dimaggio, Nicolo`, Procacci, & Carcione, in press): (1) Specialized (Baron-Cohen et al., 1985; Tooby & Cosmides, 1992; Leslie, 1994; Murphy & Stich, 2000) mechanisms are re-
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quired for psychological contents to be identified, processed, and integrated with other contents. For example, according to Nichols and Stich
(2001), detecting inner thoughts and reasoning on them are separate
skills. Detecting is the ability to identify specific mental contents in oneself. Reasoning is the ability to draw inferences about mental states and
processes. Ones reasoning skills are used in working out information
about both ones own mental states and others. In the opinion of Nichols
and Stich, the experiments by Gopnik and Slaughter (1991), with tasks
about understanding variations in desire, support the hypothesis that
there is an uncoupling between detecting and reasoning. For example,
three year old children are asked, before their snack time, whether they
want to eat. They normally reply yes. But if, after eating, they are asked
whether, at the time of the first question, they wanted to eat, they tend to
reply no, showing that they are basing themselves on their current desire
and are unaware of the variation therein. The authors interpretation is
that, while the identification of a current desire depends on a monitoring
mechanism, which is already working well at that age, the possibility of
recalling past desires and understanding variations depends on working
out and reasoning processes, which are not yet working at that age. (2)
Mechanisms involved in identifying and reasoning about states of mind
and solving problems related to them can be inadequate or defective due
to problems or lesions that to some extent are independent of the mental
contents that they are processing. For example, autistics are unable to
recognize all their own emotions and also find it difficult to identify their
own thoughts (Baron-Cohen, 1995). (3) An inability to identify states of
mind and reason about them has a negative impact on adaptation by
causing symptoms and interpersonal problems (Dimaggio et al., 2006;
Fonagy et al., 2002; Frith, 1992; Semerari et al., 2003b).
Several attempts have been made to apply these theories to clinical practice. As noted previously, autistics are thought to suffer from a serious
theory of mind deficit. Schizophrenics do not perceive their inner dialogues
as being their own (McGuire et al., 1995). Psychosomatic patients are limited in their descriptions of their emotions and, in particular, are poor at
perceiving what provokes them (Taylor, Bagby, & Parker, 1997). As regards
PD patients, our hypothesis is that they suffer from impaired metacognition, that the impairment is not uniform (Dimaggio, Semerari et al., in
press; Semerari et al., 2003, in press) and that for each PD there are different types of impairment. The malfunctioning ought to be less serious than
in autistics and psychotics; for example, no PD patient fails consistently
to identify his/her thoughts as being his/her own. Any dysfunctions ought
to also be very sensitive to trends in relationships, unlike in autistics and
psychotics, where the impairment is more constant and harder to rectify.
When there is a good emotional atmosphere, PD patients ought to display
problematic moments in relationships (Dimaggio, Semerari et al., in press;
Semerari, et al., 2003, in press). Better metacognition than in Ryle and
Kerr (2002) note that borderlines have poor self-reflective skills and thus
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swing between one self-state and another. Fonagy and colleagues (2002)
observe how borderlines are poor at integrating multiple representations of
self with others, so that they swing chaotically between extreme emotional
states, and also have limited general self-reflective skills (Fonagy et al.,
2002). However, an analysis of psychotherapy transcripts of borderline patients during the first year of therapy using the Metacognition Assessment
Scale (Semerari et al., 2003b) showed that they are good at describing their
inner states but had difficulty integrating the changeable representations
that occur with relationships into coherent narratives and had some problems differentiating fantasy and reality (Semerari, Dimaggio, Nicolo`, Pedone, Procacci, & Carcione, 2005).
Narcissists are out of touch with their own inner states (they are alexithymic; Krystal, 1998), in particular the emotions connected with the activation of the attachment systemfragility, need for attention and so on
and the desires not integrated into the grandiose self (Bowlby, 1982;
Dimaggio, Semerari et al., 2006; Kohut, 1971; Jellema, 2000). They also
find it difficult to identify any external causes for their inner states (Kernberg, 1975). They display limited empathy, are egocentric in a Piagetian
sense and lack a well-developed theory of others mind (Benjamin, 1996;
Fiscalini, 1994; Westen, 1990). Similarly, although in a more serious form,
paranoids do not decenter cognitively. They systematically interpret others gestures and expressions as being ill-intentioned and always feel involved in a relationship (Nicolo` & Nobile, 2006). The personalities that
Westen & Shedler (2000) define as schizoid are poor at making sense of
others people behavior and have little psychological insight into their motives. These same authors consider low self-reflectivity to be typical of PDs
in general.
This theoretical, observational, and empirical information suggests that
PDs are characterized by malfunctionings in specific aspects of the ability
to construct integrated representations of ones own mental representations (metarepresentations; Semerari et al., 2003b). These malfunctionings interfere with interpersonal relationships, a core assumption in Livesleys definition. For example, narcissists are incapable of identifying their
own emotions and ascribing meaning to them, so that they do not consciously seek help when in difficulty. Others do not offer them the attention that they have not asked for but, at a pre-verbal level (spontaneous
activation of attachment), expect. As a consequence, relationships become
dysfunctional.
INTERPERSONAL SCHEMAS
Relationships are problematical if the cognitive structures guiding them
are dysfunctional. Life in a complex society is impossible without tools to
enable one to foresee how interactions will evolve, prescribe which behavior to adopt, proscribe behaviors to avoid, and provide a model of the other
person and his or her intentions towards the self. Interactive procedures
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and rules for correct social interaction are also needed. These requirements are met by interpersonal schemas. People enter into relationships
based on structures formed by desires (motivations, goals), self-representations, representations of other and his or her intentions vis-a`-vis self,
and representations of the response self will make depending on others
response. Over the course of their lives, people develop a variety of such
schemas to fit different circumstances. These structures are termed: internal working models (Bowlby, 1982); representations of interactions that
have been generalized (Stern, 1985); interpersonal schemas (Baldwin,
1992; Safran & Muran, 2000); role-relationship models (Horowitz, 1998);
reciprocal role procedures (Ryle & Kerr, 2002); object relations (Fairbairn,
1952); and dialogical relationship patterns (Dimaggio, Fiore et al., 2006).
The rules or schemas develop out of relationships with others. People
look for relationships to meet ethologically determined needs such as being accepted, loved, protected, or admired, self-esteem, and so on. During
development, they create and store images of self (e.g., being undeserving
of love) and other (e.g., rejecting) around certain desires (being loved). Thus
schemas are formed with a structure such as If I ask others for love, given
that Im undeserving, they will reject me. If persons guided by such a
schema do not ask for love they are unlikely to obtain it. Nor will their
elusive attitude stimulate others to give them attention. Their idea about
being unlovable thus gets confirmed. To summarize, the schemas influence both behavior (given that I shall be rejected, I am not going to display
my desire to be loved) and others responses (Millon & Davis, 1996; Mitchell, 1988; Safran & Muran, 2000). To quote Livesley (2003):
The sequence of (1) a triggering situation evoking (2) basic schema that, in turn,
evoke (3) an experiential state, (4) behavioral response, (5) reciprocating responses from others, and (6) evaluation of outcome leading to confirmation of
the basic belief creates a cyclical interpersonal dynamic that is self-maintaining
and difficult to disrupt (p. 36).
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only such patients relationships but also the processes that get activated
during the therapeutic relationship (Safran & Muran, 2000) that are especially likely to have a negative impact on therapy. However, a descriptive
approach is more useful than attempting to deducing which dimensions underlie every human interpersonal process from a general theory.
We need to identify which interpersonal schemas crop up during PD psychotherapy. Once the set of self-other schemas typical of each PD has been
traced, then it will be possible to build a general model of the alterations
in interpersonal behavior.
The authors from the Third Centre for Cognitive Psychotherapy have
noted that each PD has its own set of problematical interpersonal schemas
and that these can be picked out in narratives and in the therapeutic relationship. Their observations regard borderline, narcissistic, dependent,
avoidant and paranoid PDs and are based on a qualitative analysis of psychotherapy transcripts (Dimaggio, Semerari et al., 2006). For example, in
paranoid PD the dominant self-representation is the weak, inadequate and
fragile and the other is seen as ill-intentioned and ready to exploit ones
weaknesses. As a result, the behavior of paranoid individuals swings from
anticipatory counter-attacks, withdrawal from relationships, and dejection due to feeling that they can no longer tackle threats (see also Millon
& Davis, 1996; Stone, 1993). The fact that they have only a limited number
of schemas together with the negative reactions these provoke in others
leads patients to experience a limited number of self-states and miss opportunities to widen their self-knowledge. If their expectations prevent
them from noticing behavior by others not foreseen in their schemas, they
are unable to take advantage of new potentially adaptive experiences. For
example, by being unable to understand that another is offering help and
not attacking, they can not access the self-receiving-help representation.
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make an optimum use of their time, resources and energies for stages a.
and b., and d. feel fully confident in the credibility of their conclusions.
Examples of reasoning pathology include, for example, inadequate reviewing of the facts, concentrating only on the focal hypothesis and not
the alternatives, and thinking too much. Heuristics are considered a
sound strategy because they render timely decision-making possible when
the information available is limited. Pathological reasoning is systematically of the pseudo-diagnostic type, with an evaluation limited to a focal
hypothesis and the ignoring of any data refuting it (Johnson-Laird, Mancini, & Gangemi, in press). On the other hand, true diagnostic reasoning
takes account of alternative hypotheses and looks for data refuting a focal
hypothesis. Heuristics do not correspond to the cognitive errors or irrational beliefs Beck (1976) or, in general, the standard Cognitive Behavior
Therapy (CBT), talks about. As regards the large majority of the results of
human thought, it is impossible to establish whether they are right or
wrong. The important question is whether a reasoning strategy facilitates
or hampers adaptation and whether people adopt it when appropriate or
use it systematically even when it would be best not to (Baron, 2000).
Overestimating danger may, for example, save ones life (Gilbert, 2002),
but if this leads one to always ascribe threatening intentions to others,
ones relational life will be very poor and affect quality constantly negative.
People make wide use of heuristics for example, in determining their
value, self-enhance (Rosenberg, 1965; Taylor & Brown, 1988). The pathology may feature formally correct reasoning; in fact depressives tend towards a realistic self-evaluation (Alloy, 1988). Certain types of heuristic
and the abuse thereof are linked to the pathology.
Better safe then sorry strategies are a widespread form of heuristic
(Gilbert, 2002; Smeets, De Jong, & Mayer, 2000). People tend to overestimate danger in the belief that it is better not to run even a limited risk
than to face a possibility, however slim, of an event that is judged to be
highly dangerous taking place. People tend, on the other hand, to ignore
that choosing to not run a limited risk also has harmful consequences
(which is in fact the case because by not running risks one can not achieve
goals) (Mancini & Gangemi, 2001). Pseudo-diagnostic reasoning leads hypochondriacs to use confirmation bias: considering only data confirming
a focal hypothesis (Im seriously ill) and ignoring those disproving it (De
Jong, Mayer, & Van den Hout, 1997; Salkovskis, 1989).
Depressives tend to confirmation bias for their pessimistic beliefs (Panzarella, Alloy, Abramson, & Klein, 1999). Obsessive patients focus on the
hypothesis that they could cause harm to themselves or others. Normal
individuals put in an experimental situation of inflated responsibility tend
to use quasi-obsessive heuristics (Ladoucer, Rheaume, Freeston, Aublet,
Jean, Lachance, Langlois, & De Pokomandy-Morin, 1995) and to make
choices of the risk-adverse type (Mancini & Gangemi, 2002). Anxiety disorders involve mainly so-called ex-consequentia reasoning, which can be
summed up by the formula: If I feel anxious, there must be a danger
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(Arntz, Rauner, & Van den Hout, 1995). Social phobics use heuristics of
the better safe then sorry type (Gilbert, 2002).
As well as reasoning processes, choices are also influenced by the information source that one selects. Emotions, for example, are a rapid form of
decision-making reasoning (Frijda, 1986; Oatley & Johnson-Laird, 1987;
Lazarus, 1966). They are so indispensable that when brain injuries hamper the ability to feel complex emotions (e.g., guilt or shame), people are
unable to make choices and their social life deteriorates (Damasio, 1994).
Given that dysfunctional reasoning is well documented in Axis I disorders, it is surprizing that there are few reports on dysfunctional reasoning
in the PDs. However, the little research reported has yielded interesting
results. Paranoids adopt better safe then sorry strategies when they feel
attacked by hostile human groups (Gilbert, 2002). It has been shown in
experiments (John & Robins, 1994; Pauhlus, 1998) and observed clinically
(Dimaggio et al., 2002) that narcissists use self-enhancement strategies to
a greater degree than normal. Narcissistic self-enhancers take credit for
success but externalize or discount failures (Rhodewalt & Morf, 1998).
They also respond to threats to self-esteem by disengaging from tasks that
were previously very important (Sedikides & Strube, 1997). In a population
of college students, those with a strong narcissistic trait tended to overestimate their academic ability, make self-serving attributions about their academic performance, disengage from the academic context when they realized that their results did not correspond to their initial, high, expectations
and show a tendency towards the end of their college courses to view results as less important (Robins & Beer, 2001). Narcissists do not heed
their inner states and let themselves be guided solely by reasoning. They
pursue life goals reinforcing their grandiose self without satisfying other
desires (Dimaggio et al., 2002; Kohut, 1971; Lowen, 1983).
Similarly, avoidant, dependent and borderline patients tend to: a. expect
there to be few satisfactions both now and in the future; b. ask for a lot of
information; c. use mainly rules to interrupt any losses rapidly; d. enjoy
any gains to a lesser extent than normal (Leahy, 2002). Paranoids, on the
other hand, feature low self-efficacy, get easily discouraged and are cautious in the face of change. Summing up, even if the research on PDs is at
an initial stage, we know enough to be able to hypothesize that: PD patients reasoning uses a series of heuristics, some of them similar to those
of non-patients or Axis-I patients, and others typical of PD patients or,
at least, more intense in these than in other populations, e.g., high selfenhancement. PD patients probably also, unlike normal individuals, use
heuristics more pervasively and inappropriately, whereas non-patients
make a more limited use of them and know to change reasoning strategy
when they see that the current one is not working. Probably as a result of
this pervasive use of heuristics patients fail at self-regulation and tend to
experience negative self-states, as occurs in paranoids, who overestimate
danger and, as a result, find it impossible to live in society without terrible
conflicts and a devastating sense of anger or low self-efficacy.
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ship, which metacognitive skill profiles are typical of each PD (if this is the
case), and how therapy can help patients to improve these skills. It requires single case designs that are costly and time-consuming. Moreover,
it involves organizational aspects, for example, the processes bringing
about transitions, that it is difficult to verify empirically. However, when it
is not possible to induce laws, collect empirical data or calculate algorithms, sciences (i.e., biology) make ample use of models defining how any
observed phenomena are regulated by general principles. Cosmology and
the theory of evolution have had to face problems like this but this has not
resulted in them dying out.
Overall, the elements listed and the links between them seem to have
the right characteristics for being a good description of the self pathology
to be found in Livesleys definition of PD where we started out. The model
we have expounded explains how individuals fail in: a. integrating multiple
representations of self and other (metacognitive dysfunctions hamper
uniting states of mind and images of self with other); b. interpersonal adaptation (interpersonal schemas leading to problematical behavior and
generating actions that alienate others); and c. social functioning (interpersonal schemas again and the heuristics used leading them to make
negative and detrimental choices). In spite of the limitations and partly
speculative nature of the approach described, we believe that it is sufficiently well-grounded to be considered a scientific hypothesis worth discussion and investigation.
REFERENCES
Alloy, L. B. (Ed.). (1988). Cognitive processes
in depression. New York: Guilford.
American Psychiatric Association. (2000).
Diagnostic and Statistical Manual of
Mental Disorders. 4th edition. DSMIV-TR. Washington, DC: American
Psychiatric Association.
Angus, L., & McLeod, J. (Eds.). (2004). The
handbook of narrative and psychotherapy: Practice, theory and research.
Thousand Oaks, CA: Sage.
Allport, G. W. (1937). Personality: A psychological interpretation. New York:
Holt.
Applebaum, S. A. (1973). Psychologicalmindedness: Word, concept and essence. International Journal of Psychoanalysis, 54, 3545.
Arntz, A., Rauner, M., & Van den Hout, M.
(1995). If I feel anxious there must be
dangers: Ex-consequentia reasoning
in inferring danger in anxiety disorder.
Behaviour Research and Therapy, 33,
917925.
613
614
talization, and the development of the
self. New York: Other Press.
Frith, C. D. (1992). The cognitive neuropsychology of schizoprenia. Hove: Erlbaum.
Frijda, N. H. (1986). The Emotions. Cambridge: Cambridge University Press.
Gazzaniga, M. S. (1988). The dynamics of cerebral specialization and modular interactions. In L. Weiskrantz (Ed.),
Thought without language (pp. 430
450). Oxford, UK: Clarendon Press.
Gallese, V., & Lakoff, G. (2005). The brains
concepts: The role of the sensorymotor system in reason and language.
Cognitive Neuropsychology, 22, 455
479.
Gilbert, P. (2002). Evolutionary approaches
to psychopathology and cognitive therapy. Journal of Cognitive Psychotherapy, 16, 263294.
Golynkina, K., & Ryle, A. (1999). The identification and characteristics of the partially dissociated states of patients
with borderline personality disorder.
British Journal of Medical Psychology,
9, 429445.
Goncalves, O. F., & Machado. P. P. (1999).
Cognitive narrative psychotherapy:
Research Foundations. Journal of Clinical Psychology, 55, 11791191.
Gopnik, A., & Slaughter, V. (1991). Young
children understanding of changes in
their mental states. Child Development, 62, 98110.
Guidano, V. F., & Liotti, G. (1983). Cognitive
processes and emotional disorders.
New York: Guilford.
Habermas, T., & Bluck, S. (2000). Getting a
life: The emergence of the life story in
adolescence. Psychological Bulletin, 126,
748769.
Hermans, H.J.M. (1996). Voicing the self:
From information processing to dialogical interchange. Psychological Bulletin, 119, 3150.
Hermans, H.J.M., & Dimaggio G. (Eds.).
(2004). The dialogical self in psychotherapy. London: Brunner-Routledge.
Hermans, H.J.M., & Hermans-Jansen, E.
(1995). Self-narratives: The construction of meaning in psychotherapy. New
York: Guilford Press.
Higgins, E. T., & Bargh, J. A. (1987). Social
cognition and social perception. Annual
Review of Psychology, 38, 369425.
Horowitz, M. J. (1998). Cognitive psychodinamics: From conflict to character. New
York: Wiley.
DIMAGGIO ET AL.
Jellema, A. (2000). Insecure attachment
states: Their relationship to borderline
and narcissistic personality disorders
and treatment process in cognitive analytic therapy. Clinical Psychology and
Psychotherapy, 7, 138154.
John, O. P., & Robins, R. W. (1994). Accuracy and bias in self-perception: Individual differences in self-enhancement
and the role of narcissism. Journal of
Personality and Social Psychology, 66,
206219.
Johnson-Laird, P. N., Mancini, F., & Gangemi,
A. (in press). A hyper-emotion theory
of psychological illnesses. Psychological Review.
Kelly, G. (1955). The psychology of personal
constructs. New York: Norton.
Kernberg, O. F. (1975). Borderline conditions
and pathological narcissism. Northvale, NJ: Aronson.
Kohut, H. (1971). The analysis of the self.
New York: International University
Press.
Krystal, H. (1998). Affect regulation and narcissism: Trauma, alexithymia and psychosomatic illness in narcissistic patients. In E. F. Ronningstam (Ed.),
Disorders of narcissism: Diagnostic,
clinical, and empirical implications (pp.
299326). New York: American Psychiatric Press.
Ladoucer, R., Rheaume, J., Freeston, M. H.,
Aublet, F., Jean, K., Lachance, S.,
Langlois F., & De Pokomandy-Morin,
K. (1995). Experimental manipulations of responsibility: An analogue
test for models of obsessive-compulsive disorder. Behaviour Research and
Therapy, 33, 937946.
Lazarus, R. S. (1966). Psychological stress
and the coping process. New York: McGraw-Hill.
Leahy, R. L. (2002). Decision making and
personality disorders. Journal of Cognitive Psychotherapy: An International
Quarterly, 16, 209225.
Leslie, A. M. (1987). Pretense and representation: The origin of theory of mind.
Psychological Review, 94, 412426.
Leslie, A. M. (1994). ToMM, ToBy, and
Agency: Core architecture and domain
specificity. In L. Hirschfeld & S. Gelman
(Eds.), Mapping the mind: Domain specificity in cognition and culture. Cambridge, MA: Cambridge University Press.
Livesley, W. J. (1998). Suggestions for a
framework for an empirically based
615
616
tions to mental illness and mental
health. In F. T. Durso, R. S. Nickerson,
R. W. Schvaneveldt, S. T. Dumais,
D. S. Lindsay, & M.T.H. Chi (Eds.),
Handbook of applied cognition. New
York: Wiley.
Paulhus, D. L. (1998). Interpersonal and
intrapsychic adaptiveness of trait selfenhancement: A mixed blessing? Journal of Personality and Social Psychology, 74, 11971208.
Perris, C. (1999). A conceptualization of personality-related disorders of interpersonal behaviour with implications for
treatment. Clinical Psychology and
Psychotherapy, 6, 239260.
Piaget, J. (1964). Six etudes de psychologie.
Paris: Gonthier, Mediations.
Pincas, A. L., & Wiggins, J. S. (1990). Interpersonal problems and conceptions of
personality disorders. Journal of Personality Disorders, 4, 342352.
Rhodewalt, F., & Morf, C. C. (1998). On selfaggrandizement and anger: A temporal
analysis of narcissism and affective reactions to success and failure. Journal
of Personality and Social Psychology,
74, 672685.
Rosenberg, M. (1965). Society and the adolescent self-image. Princeton: Princeton
University Press.
Robins, R. W., & Beer, J. S. (2001). Positive
illusions about the self. Journal of Personality and Social Psychology, 80,
340352.
Ryle, A., & Kerr, I. (2002). Introducing cognitive analytic therapy. Principles and
practice. Chichester: Wiley.
Safran, J. D., & Muran, J. C. (2000). Negotiating the therapeutic alliance. A relational treatment guide. New York: Guilford.
Salkovskis, P. M. (1989). Cognitive-behavioural factors and the persistence of
intrusive thoughts in obsessional
problems. Behaviour Therapy and Research, 27, 677682.
Salvatore, G., Dimaggio, G., & Semerari, A.
(2004). A model of narrative development: Implications for understanding
psychopathology and guiding therapy.
Psychology and Psychotherapy, 1,
125.
Salvatore, G., Nicolo`, G., & Dimaggio, G.
(2005). Impoverished dialogical relationship patterns in paranoid personality disorder. American Journal of
Psychotherapy, 59, 247265.
DIMAGGIO ET AL.
Sarbin, T. R. (1986). The narrative as a root
metaphor for psychology. In T. R. Sarbin (Ed.), Narrative psychology: The
storied nature of human conduct (pp.
127). New York : Praeger.
Sedikides, C., & Strube, M. J. (1997). Selfevaluation: To thine own self be good,
to thine own self be sure, to thine own
self be true, and to thine own self be
better. In M. P. Zanna (Ed.), Advances
in experimental social psychology (pp.
209269). New York: Academic Press.
Segal, Z. V. (1988). Appraisal of the self
schema: Construct in cognitive model
of depression. Psychological Bulletin,
103, 147162.
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo`, G., Procacci, M., &
Alleva, G. (2003a). How to evaluate
metacognitive funtioning in psychotherapy? The Metacognition Assessment Scale and its applications. Clinical Psychology and Psychotherapy, 10,
238261.
Semerari, A., Carcione, A., Dimaggio, G., Falcone, M., Nicolo`, G., Procacci, M.,
Alleva, G., & Mergenthaler, E. (2003b).
Assessing problematic states inside
patients narratives. The Grid of problematic conditions. Psychotherapy Research, 13, 337353.
Semerari, A., Dimaggio, G., Nicolo`, G., Pedone, R., Procacci, M., & Carcione, A.
(2006). Metarepresentative functions
in borderline personality disorders.
Journal of Personality Disorders, 19,
690710.
Semerari, A., Dimaggio, G., Nicolo`, G., Procacci, M., & Carcione, A. (in press).
Understanding minds, different functions and different disorders? The contribution of psychotherapeutic research.
Psychotherapy Research.
Shedler, J., & Westen, D. (2004). Dimensions of personality pathology: An alternative to the Five Factor Model.
American Journal of Psychiatry, 161,
17431754.
Singer, J. A., & Bluck, S. (2001). New perspectives on autobiographical memory: The integration of narrative processing and autobiographical reasoning.
Review of General Psychology, 5,
9199.
Smeets, G., De Jong, P. J., & Mayer, B.
(2000). If you suffer from a headache,
than you have a brain tumor: Domain
specific reasoning bias and hypo-
617